1356627285 NPI number — BELINDA MERCEDES LEPERVANCHE DPT

Table of content: BELINDA MERCEDES LEPERVANCHE DPT (NPI 1356627285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356627285 NPI number — BELINDA MERCEDES LEPERVANCHE DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEPERVANCHE
Provider First Name:
BELINDA
Provider Middle Name:
MERCEDES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARCIA
Provider Other First Name:
BELINDA
Provider Other Middle Name:
MERCEDES
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1356627285
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17842 NW 2ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEMBROKE PINES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33029-2806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-704-3384
Provider Business Mailing Address Fax Number:
954-435-0624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17842 NW 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBROKE PINES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33029-2806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-704-3384
Provider Business Practice Location Address Fax Number:
954-435-0624
Provider Enumeration Date:
10/24/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  23752 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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